Realistic Expectations for Zepbound and Wegovy GLP-1 Hub Founder: Ana Reisdorf
What does it really look like to set realistic expectations with weight loss medications like Zepbound and Wegovy?
That’s the focus of today’s episode, and I’m joined by someone who knows this topic inside and out—Ana Reisdorf, a registered dietitian with over 15 years of experience. Ana is the founder of the GLP-1 Hub, where she provides resources, education, and support for people using GLP-1 medications. She also hosts a podcast dedicated to helping patients navigate the ups and downs of this journey.
In our conversation, Ana shares why setting realistic expectations is so important—from understanding how dosing really works, to rethinking nutrition, and even reframing what progress looks like beyond the scale. She also points out common mistakes, like rushing to the highest dose too quickly or overly restricting food, and offers practical guidance on how to avoid them.
At the heart of this discussion is Ana’s message that success with GLP-1s isn’t just about weight loss—it’s about long-term health, balanced nutrition, and finding an approach that feels sustainable.
Nutrition: An Overlooked Expectation
One of the biggest misconceptions about weight loss medications is that success depends only on cutting calories. Many people go in with the mindset that food becomes less important, when in reality, nutrition matters just as much—if not more—once the medication starts working.
Malnutrition is a real risk, and it can cause serious problems much faster than obesity ever could. What often surprises people is that both can exist at the same time. Carrying extra weight doesn’t guarantee the body is getting the nutrients it needs. Without enough vitamins, minerals, and macronutrients, energy drops, organs don’t function as well, and overall health suffers.
This is why it’s important to set the right expectation: food isn’t the enemy, and protein isn’t the only priority. The body also needs fruits, vegetables, whole grains, and healthy fats to stay strong and balanced. Restricting too much, or focusing only on one food group, often backfires in the long run.
The most sustainable approach is actually the simplest—eat from all the food groups. A balanced diet naturally covers nutrient needs without requiring obsessive tracking or rigid restriction. Weight loss medications can help manage hunger, but it’s nutrition that helps maintain health along the way.
When expectations are realistic, the focus shifts. Instead of trying to eat less and less, the goal becomes eating well—fueling the body in a way that supports both weight loss and long-term health.
Why Slower, Personalized Dosing Matters
When people start weight loss medications, dosing is often the first concern. Many assume that the higher the dose, the faster the results. But these medications aren’t meant to be rushed. The FDA advises waiting at least four weeks between adjustments so the body can adapt and progress can be evaluated. There is no universal “best” dose—the right one is the level that works without causing unnecessary side effects.
Not everyone needs the maximum dose. Some see steady progress and feel well at lower levels. Increasing too quickly or going higher than necessary often leads to nausea, fatigue, or other side effects that make daily life harder. When medication becomes unpleasant, people are more likely to stop altogether—an outcome that could have been avoided with a slower, more personalized approach.
That’s why communication with a provider is so important. The best results come from a collaborative process where dosing decisions are based on both progress and well-being. The goal isn’t just fast weight loss, but a safe, sustainable plan that allows for real life—enjoying meals, nourishing the body, and staying healthy for the long term.
Rethinking Plateaus and Progress
A major challenge in weight loss is managing expectations—especially when progress gets compared to someone else’s. It’s common to wonder, “How much did you lose on this dose?” or “Did you drop more weight on 10 mg than on 5?” But those questions don’t really matter. There isn’t a magical dose that guarantees identical results. Weight loss is highly individual, influenced by biology, lifestyle, and even something as simple as last night’s sodium intake.
A healthy, sustainable pace is usually about half a pound to two pounds per week. Some weeks it’s more, some weeks it’s less, and sometimes the scale doesn’t move at all. That doesn’t mean the medication has failed or that progress has stopped—it’s simply how weight loss works. Large studies may show smooth, steady graphs, but an individual’s journey usually looks more like a staircase: a pause, then a drop, sometimes even a small gain, before the downward trend continues.
This is why comparison so often leads to frustration. What works for one person on a certain dose may not be the same for another. And chasing a specific number—whether it’s a high school weight, a BMI target, or a vacation goal—rarely delivers the satisfaction people expect. Shifting the focus to health and quality of life tells a truer story. Less joint pain, more energy, better blood pressure, and improved labs often show up long before any “ideal weight” is reached. Weight loss medications are tools, not magic, and they work best when progress is measured by improved health and well-being rather than the scale alone.
Why “Responder” and “Non-Responder” Don’t Tell the Whole Story
When talking about weight loss medications, people often hear the terms responder and non-responder. While common, these labels can be misleading. Some individuals seem to be what I call “super responders,” losing 50 or more pounds on the lowest dose. Others assume they’re “slow responders” because progress feels gradual, even though they’re losing two to six pounds a month—the exact rate considered healthy. Only a small number truly don’t respond, and in those cases, working with a provider can help uncover other strategies.
The issue with labels is that they create fixed expectations. Someone who loses quickly early on may slow down later, while another who starts slow might steadily progress for a year. Weight loss is rarely predictable, and categorizing too early risks overlooking the bigger picture.
Clinical trials make this clear. In Wegovy studies, participants lost weight for up to 48 weeks, and in Zepbound trials, people continued losing for as long as 72 weeks. These medications are not designed for quick fixes—they work gradually over time. Expecting dramatic changes in just a few months sets people up for disappointment.
It helps to remember that weight gain doesn’t happen overnight. It builds gradually, often over years, and the process of losing weight follows a similar pattern. Steady progress, even if it feels slow, is still progress. Labels like responder and non-responder oversimplify a complex journey. The real goal isn’t to fit into a category—it’s to move toward better health at a pace that can be sustained long term.
Why Not Every Food Needs to Be a Protein Food
It often feels like society has become obsessed with protein. Everywhere you look, there’s a new product boasting its protein content—protein bars, protein chips, even protein chocolate. Protein is undeniably important. It plays a role in satiety, muscle health, and blood sugar regulation. But somewhere along the way, the message got stretched too far, as if every single food needs to be packed with protein.
The truth is, not everything has to be a “protein food.” Adding protein powder or fortification to every snack can sometimes take away from the food itself, rather than enhance it. That doesn’t mean innovative options don’t have value. For people who struggle to get enough protein, having products like high-protein bagels can be a helpful tool. They allow for more flexibility and make it easier to meet daily needs without forcing major dietary changes.
The issue comes when protein becomes the only focus. In the rush to prioritize protein, people often forget about fruits, vegetables, whole grains, and other nutrient-rich foods that are equally important for overall health. These foods provide vitamins, minerals, and fiber that protein alone can’t replace.
This imbalance shows up often in conversations about what to eat while taking GLP-1 medications. Many expect protein to be the number one priority, and some are even surprised—or frustrated—when it isn’t placed at the top of the list. While protein matters, so does balance. Building a diet that supports health isn’t about elevating one macronutrient above all others, but about creating variety and giving the body a mix of what it truly needs.
The Overlooked Nutrient That Supports Gut Health on GLP-1s
Fiber doesn’t get the same attention as protein, but it plays a critical role—especially for people on GLP-1 medications. Since these medications slow digestion, constipation can become a common side effect, often worsened by diets high in protein but low in fiber.
Beyond digestion, fiber supports satiety by adding bulk without extra calories. High-fiber foods—fruits, vegetables, beans, legumes, and whole grains—also deliver key nutrients. Unfortunately, many people avoid these foods because they contain carbohydrates. The reality is that carbs from fiber-rich sources aren’t just safe to eat—they’re beneficial.
When fiber intake is too low, constipation can become difficult to manage. While supplements can help, getting fiber from whole foods is often more effective and enjoyable. Simple swaps, like blending fruit into a shake or adding beans to a meal, can make a big difference. Still, balance matters—adding too much fiber too quickly can cause bloating or discomfort.
This ties into a bigger message: health doesn’t come from prioritizing one nutrient above all others. Protein, fiber, and carbohydrates each have their place, and sustainable health comes from variety and moderation. Many patients on GLP-1s discover for the first time that they can enjoy balanced meals, feel satisfied, and let go of restrictive food rules.
The challenge is that not everyone has access to a dietitian to help guide these changes, since nutrition counseling often isn’t covered by insurance. Yet the need is clear—dietitians can provide practical support and reassurance around building balanced meals. Until that gap is closed, the key takeaway is simple: balance matters. Fiber, protein, and all nutrients work best together, supporting both health and long-term success.
Common Mistakes When Starting GLP-1 Medications
One of the most common mistakes people make when starting a medication like Zepbound or Wegovy is not fully understanding how the medication works. Many go in with the mindset of, “I’ll take the medication, lose the weight, stop, and everything will be fine.” That sounds logical, especially for those who already have healthy habits with food and exercise. But for most, it doesn’t work that way. These medications aren’t a quick fix; they’re a tool that works best when paired with long-term lifestyle support.
Another mistake is overlooking strength training. It’s easy to think, “I’m losing weight, I can skip the gym.” But skipping resistance exercise can come at the cost of losing muscle. Some notice flabby arms or changes in body composition even while the scale is going down. Incorporating strength training early on helps preserve lean muscle and supports metabolism. For example, forms of exercise like Pilates or resistance-based workouts can be incredibly effective for maintaining muscle while still reaping the benefits of weight loss.
The positive side is that many people already have healthy eating patterns—they’re choosing fruits, vegetables, whole grains, and balanced meals. The challenge isn’t always the what but the how much. These medications help by controlling hunger and allowing individuals to feel satisfied with the portions their body truly needs. For some, that’s the missing piece that finally makes everything click.
In the end, the key takeaway is this: GLP-1 medications are not a shortcut but a support system. Pairing them with strength training, balanced eating, and realistic expectations can make the difference between short-term results and sustainable change.
Nutrition Matters: Why Eating Enough Is Just as Important as Weight Loss
Our guest wants to share one of their core messages—something simple, but often overlooked: the body needs food, and it needs real nutrition. Too often, the conversation around obesity focuses only on losing weight. But malnutrition can be just as serious, and in many cases, its effects show up much faster.
The tricky part is that malnutrition doesn’t always look the way people think it does. Someone can be living with obesity and still be malnourished. Extra calories don’t automatically mean the body is getting the vitamins, minerals, and nutrients it needs. Without that balance, the body can’t function the way it should.
That’s why all the food groups matter. Protein is important, yes—but so are fruits, vegetables, whole grains, and healthy fats. Cutting out too much in the name of dieting can actually backfire. Often, the simplest approach works best: eat a variety of foods, and the nutrients will fall into place naturally.
The takeaway is straightforward: don’t be afraid of food. Balanced meals aren’t just about weight management—they’re about giving the body the fuel it needs to feel good, stay healthy, and thrive long term.
From nutrition to dosing, to navigating plateaus and letting go of comparisons, Ana reminds us that this journey is about more than just chasing a number on the scale—it’s about building a sustainable path to better health. If you enjoyed this episode, be sure to follow the show so you don’t miss what’s coming next. Until then, take care, stay consistent, and remember: progress isn’t about perfection, it’s about moving in the right direction.
More from The Dr. Francavilla Show:
Subscribe to The Dr. Francavilla Show on